Provider Demographics
NPI:1518040419
Name:AHLQUIST, ADRIENNE W (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:W
Last Name:AHLQUIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:E
Other - Last Name:WERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:737 MILLERSBURG ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-4079
Mailing Address - Country:US
Mailing Address - Phone:630-209-2965
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 380
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7710
Practice Address - Country:US
Practice Address - Phone:630-209-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490098721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical